Orthopaedic Surgery/Staging of Tumours

Benign soft tissue tumors are classified using the musculoskeletal tumor society staging system. Arabic numerals denote benign condidtions and Roman numerals malignant. Stage 1 inactive Stage 2 active Stage 3 locally aggressive. Marginal section is appropriate for the first two categories whereas wide local excision is appropriate for the third.

Superficial lesions less than 1.5 cm especially with slow growth characteristics,assymtomatic, non-fixed and soft are suitable for excisional biopsy, otherwise incisional biopsy if fine needle or core biopsy is not your preferred approach. Beware the ganglion cyst that isn't. Upon encountering instead a solid tumor which does not appear to be a giant cell tumor of tendon sheath or a schwannoma, or a hemangioma which have fairly characteristic appearances, avoid the temptation to proceed directly to marginal resection, instead, perform an incisional biopsy. If a malignant lesion is encountered then close, observing meticulous hemostasis. Layered closure, tourniquet deflated first to confirm hemostasis, compressive bulky dressing. After the fact is the wrong time to then check for adenopathy. It is also too late to take back that esmarch exsanguination. It is also too late to take back the transverse incision and the subcutaneous flap, and the exposure of major neurovascular structure that might have been avoided. In other words, plan the approach to even benign lesions as if you are about to encounter an unexpected malignant fibrous histiocytoma, or synovial sarcoma or epithelioid sarcoma.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8727762